Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery

Abstract

Aim: To evaluate whether surgical treatment for anterior chronic exertional compartment syndrome (CECS) of the lower leg will lead to full athletic activity recovery compared to conservative treatment. Methods: Patients diagnosed with anterior CECS of the leg were offered surgical treatment, as surgery considered today to be the mainstay of treatment. Patients unwilling to be treated surgically were treated conservatively. They were followed up, assessing both groups for pain, functional status, and the Tegner sports activity score with comparisons at diagnosis and following treatment. Results: Forty-three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16-54.09) months. Reported pain improved at follow-up by 1.59 (0-6) points and by 4.27 + (0-10) points in the conservatively and the surgically treated patient groups, respectively (p ¼ 0.014) with a mean change in the Tegner score of 0.09 (À5 to 5) and 3.22 (À4 to 7), respectively (p ¼ 0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level (p ¼ 0.001). Conclusion: This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity.

Chronic Exertional Compartment Syndrome in the Leg: Comparing Surgery to Conservative Therapy

“…No significant difference in return to physical activity after treatment was found in the current study population. In contrast, earlier studies revealed a higher return to activity rate after surgical treatment compared to conservative treatment [23,24]. Interest-ingly, our results showed a trend towards a higher return rate among conservatively treated patients (conservative 83 % vs. surgery 74 %).…”

“…The three different types of lower leg CECS, including combinations, were not separately evaluated. Our study design is different from previously published cohorts focusing on the anterior compartment only [22][23][24]. For instance, the study by Packer et al [23] found higher satisfaction rates in patients only receiving a fasciotomy for the anterior compartment compared to patients undergoing surgery for multiple compartments.…”

“…The choice for either conservative or surgical treatment for CECS is largely based on clinical experience but not on sound evidence. However, current literature appears to favor a surgical intervention, even though recent studies have shown successful conservative treatment in specific patient groups [6,8,18,[22][23][24][25]. In addition, most studies are biased due to small sample sizes and a high variety in outcome measurements.…”

Release of the Tibialis Posterior Muscle Osseofascial Sheath Improves Results of Deep Exertional Compartment Syndrome Surgery: A Comparative Analysis and Long-term Results

“…More recent studies have done the same and have included measures such as the Tegner activity scale, SF-12, and the Euro-Qol-5D index score. 2,8,23 Future studies looking at the operative treatment of CECS may continue to include these additional outcome measures to more accurately compare results of treatment techniques and develop a more standardized definition of success in the treatment of CECS. Based on the outcome data from this retrospective study, a power analysis for a future prospective study (2group design) was performed to better delineate the sample size required to reach a clinically significant conclusion when using these validated patient outcome measures.…”

“…More recent studies have done the same and have included measures such as the Tegner activity scale, SF-12, and the EuroQol-5D index score. 2 , 8 , 23 Future studies looking at the operative treatment of CECS may continue to include these additional outcome measures to more accurately compare results of treatment techniques and develop a more standardized definition of success in the treatment of CECS.…”